Provider Demographics
NPI:1750413886
Name:MAO, TAI K (DDS)
Entity type:Individual
Prefix:DR
First Name:TAI
Middle Name:K
Last Name:MAO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9925 LAS TUNAS DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-2211
Mailing Address - Country:US
Mailing Address - Phone:626-286-3033
Mailing Address - Fax:626-286-3661
Practice Address - Street 1:9925 LAS TUNAS DR
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-2211
Practice Address - Country:US
Practice Address - Phone:626-286-3033
Practice Address - Fax:626-286-3661
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA499351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice